Fracture securing instrument



March 17, 1953 A. T. PURIFICATO FRACTURE SECURING INSTRUMENT 2SHEETS-SHEET 1 Filed July 22, 1948 /7L FRED 7T PUP/Flam,

March 17, 1953 A. T. PURIFICATO 2,631,584

FRACTURE SECURING INSTRUMENT Filed July 22, 1948 2 SHEETS-SHEET 2Il'iilll rllliiiil. rililllil Patented Mar. 17, 1953 UNITED STATES rem"OFFICE 16 Claims.

This invention relates to improvements in fracture securing instruments,adapted especially for securing bone fractures by the insertion of anail therein, or for removal of the nail therefrom.

Various attempts have been proposed heretofore to secure fracturedbones, usually by nails or screws, but these generally have not beensatisfactory for various reasons. In fractured hips, especially when thefracture in the continuity of bone occurs in the neck close to the headportion, Smith Peterson nails, Lorenzo screws and multiple long screwsfail to maintain reduction. The head fragment is so small and thestructure of the bone through which these instruments pass is so softthat disengagement usually occurs. Most operators will not attemptnailing in such cases. Since most cases of this type of fracture occurin elderly individuals complications due to stasis are common and toofrequently terminal. If they survive they live in continuous pain. Theaffected limb is shortened as a result of disengagement and absorptionof the fragments.

The object of this invention is to eliminate the objections to nails andscrews as proposed heretofore, some of which have been mentioned above,and to improve the construction of a fracture nail and an instrument forinserting and removing the same whereby the fracture may be securedefiectively and with little pain and suffer,- ing as compared with thatencountered heretofore.

This instrument is so devised and constructed that when properly used itwill not only hold two fragments in apposition but will also impact.them, making rotation and separation of fragment impossible. When theinternal portion of the nail or pin is forced into the bone frag- ,mentits curved tip exerts both a wedge and grip action. This gives theoperator full control of all. of the movements of the fragment. The nail:proper still offers all the advantages of the various types of nailsand screws now in use. .-.The hook like action of the inner pin coupledwith the function of the nail proper grips one fragment and keeps bothfragments in alignment. ,The nail itself is fitted with a cap that canbe .tightened at will and to an extreme degree. When the cap istightened the entire instrument, nail and projection curve pin, producesa vise-like action causing impaction of the bone fragments. .As long asthe cap remains set the impaction cannot be disturbed.

a Proper introduction of the instrument under discussion allows theinternal pin to be arched daterally beyond the limits of the centralcaneither proved best for plain steel.

cellous bone and to become imbedded in the firm structure of thesubcortex and the inner layers of the cortex proper. The internal pin inits laterally curved course toward the circumference of the head reachesa point beyond the circumference of the neck, thereby interposing hardbone between the hooked end of the pin and the cap. The impacting actionof the screw-cap completes the process of obtaining fixed impaction.

A nail that encounters a knot at a point some distance beneath thesurface of wood in the process of being driven will deflect its courseor will bend. This, providing the deflecting angle is not too acute. Ifso, it will bend at a point of least resistance above the knot. Thecasing of the nail and the increase in diameter of the driver andextractor rod offers more resistance to the internal pin than thatoffered at the incline plane of the foramen. Therefore it will therechange its course.

Since steel, stainless steel, SMO, vitallium, etc. possess malleabilityand flexibility or bending and retaining properties within certaindegrees, the course of the pin will change providing the angle is nottoo acute. The more obtuse the angle, the

easier it will bend while the opposite is also true until impaction orbreaking occurs. However, by experimenting with stainless steel and SMO,an angle of 50 proved satisfactory when the diameter of the pin waswhile 45 and as Other factors such as heat treated metals must also beconsidered. The driver and extractor rod in its use undergoes thegreatest amount of strain in this apparatus in the process of extractingthe internal pin; therefore in its construction, hard heat treated metalshould be used. The material used in mak-' ing the internal pin must beof good quality and flawless, and should possess no irritatingproperties to harm the tissues in which it is placed. SMO, vitallium,etc. are examples. The same is true of the nail proper and its cap.Suitable material for construction of the remaining articles is a goodquality of stainless steel.

One embodiment of the invention is illustrated in the accompanyingdrawings in which:

Fig. 4 is a longitudinal sectional view through the nail, showing thepin in elevation;

Fig. 5 is a longitudinal sectional view, showing the nail and pininsertion instrument;

Fig. 6 is a similar View, showing the pin extraction instrument; and

Fig. 7 is a similar view, showing the nail extraction instrument.

The fracture nail is shown generally in Figs. 3 and 4 and has a bodydesignated by the numeral I, having a pointed lower end 2 and a head 3on the opposite end externally screw-threaded to receive a portion ofthe instrument or a cap 4. The nail i is tubular in form, having a.passageway 5 therethrough from its upper end. The head 3 of the nail Ihas a neck connecting the head and the body and of gradually increasingdiameter from the body end, which would cause impaction of the fractureby means of the force used in insertng the nail through the fracture.The tightening of the cap i on the head 3 produces and maintainsforceful impaction of the fracture.

The end portion of the passageway 5 is inter nally screw-threaded at 6,adapted to receive a portion of the instrument as hereinafter described.The opposite end of the passageway ii is formed with a reduced shoulderl therein adjacent to an angular drilled hole 8, one wall of which isdesignated 9 and is drilled at an angle to the longitudinal axis throughthe nail.

The passage 5 is adapted to receive a fracture securing pin W, the bodyof which is internally threaded at one end at i i (Fig. 5) while theopposite end of the pin is reduced in size relative to the body asindicated in i2 and is adapted to extend through the reduced portion ofthe passageway 5 and to engage the shoulder 53 to be deflected laterallyas shown in Figs. 1, 5 and 6 when force is applied to the outer end ofthe pin.

The instrument for inserting or removing the nail and pin is shown indetail in Figs. 5 to 7. This instrument comprises a driving andextracting sleeve generally indicated at 13, provided with a cap i onone end thereof, which cap is detachable as by a screw-threadedconnection with the end of the sleeve !3. Cap i i is employed during theinsertion of the nail and pin, while cap i4 (Figs. 6 and 7) is usedduring the nail and pin extraction operations. The two caps, 14 and I l,are identical in construction except that [4 has no threaded connectionwith the bolt IS. The opposite end of the sleeve I3 is internallythreaded at 95 for detachable connection of a pin guide l6 thereto whenthe instrument is used as shown in Figs. 5 and 6. One end of the :pinguide has a screw-threaded connection with the adjacent end of the screw13, while the opposite end of said pin guide is provided with aninternally threaded socket ll, adapted for threaded connection with thehead of the nail i, as shown in Figs. 5 and 6.

Extending longitudinally through the sleeve i3, is a bolt [8, havingexternally screw-threaded connection with the cap i l, and extendingoutwardly therethrough. The projecting end portion of the bolt 18 isadapted for screw-threaded connection with a T-nut l9, which may beloosely threaded on the bolt i8, as shown in Fig. 6, or secured tightlythereon by an Allan nut 20, in the position shown in Fig. 5, which Allannut 20 engages in a depression (not shown) in the proximal end of thebolt IE to secure the T-nut in a fixed position for the purpose ofdriving 4 the internal pin. An internally threaded socket St is formedin the proximal end of bolt 18, the socket being coaxial with respect tothe longitudinal axis of the bolt, and serves a purpose to be described.

This T-nut I9 may be provided with a mark or indicia on the upper facethereof, to indicate the position of the lateral recess for the screw 20in the bolt IS. A similar mark or indicia is shown at 2i on the end ofthe nail l in Fig. 3 to indicate the position of the foramen.

For inserting the pin ill, a rod 22 has one end 32 disposed in a socket23 in the lower end of the bolt iii which is free to rotate therearound,while the opposite end portion of rod 22 extends downwardly through thepin guide it and through the nail 5, having a reduced lower end inthreaded engagement with the socket H in the pin It as shown in Fig. 5.This provides a positive connection with the pin, which permits thelatter to be forced through the nail and deilected laterally as shown inFig. 5. In forcibly removing the pin It, the cap it is substituted forcap i4 and the rod i8 is reversed in order to establish a screwthread'connection between the internally threaded socket 343 and thethreaded end 32 of the rod 22 as shown in Fig. 8.

When it is desired to remove the nail from the bone, the rod 22 may beremoved after the extraction of the pin, and the bolt is can beconnected directly with the nail I through a coupling member 25. Thecoupling member 25 has a reduced end adapted for screw-threadedengagement into an enlarged socket 28 in the lower end of the bolt [8concentric with the socket 23, which latter forms a continuationthereof, while the opposite end of the coupling member 25 engages inscrew-threaded connection with the internally threaded portion 6 of thenail The use of the instrument and the nail will be evident from theforegoing description and as hereinafter described, it being shown inFig. 1 applied to a bone fracture, and in Fig. 2 the nail is shownapplied to a bone plate, generally designated at 2? and secured in theusual manner.

The nail consists of a neck of gradually increasing diameter for thepurpose of causing impaction on insertion. Said nailpossesses a headwhich is threaded for the'purpose of engaging a screwed nut cap, saidscrewed nut cap being threaded on the inside to a depth greater than thelength of the head so that when the nail is inserted and the cap istightly applied, the base of the cap would cause pressure upon the outersegment of a fracture producing forced impaction.

The depth and length in which the internal pin can be inserted is ofgreat importance in reaching hard, dense, subcortical bony tissue.

The length of which the lateral deflection of the pin can be controlledby the operator'to any desired depth is for the purpose of engaging andpreventingrotation of one fragment of a Iracture. I

While the invention has been illustrated and described in oneembodiment, it'is recognized that variations and changes may be madetherein without departing from the invention except as specified in theclaims.

I claim:

1. An instrument'for securing fragmentsof a bone fracture, comprising atubular nail, having an offset opening in a side thereof, withan'angular face extending traversely of the axis of the nail, a pinslidably mounted'and-entirelycontained within the nail, said pin havinga shank in position to engage said face and to be deflected laterallythrough the opening, means connected with the nail for holding said nailin place, and means in position to apply continuous pressure to said pinmoving said pin relative to the nail and against the angular facewhileheld by the first mentioned means.

2. An instrument for securing fragments of a bone fracture, comprising atubular nail, having an offset opening in a side thereof, with anangular face extending traversely of the axis of the nail, a pinslidably mounted and entirely contained within the nail, said pin havinga shank in position to engage said face and to be deflected laterallythrough the opening, a tubular guide connected with the nail, andpressure applying means operatively connected with the guide and inposition to move the pin relative to the nail against the angular facefor deflection thereby.

laterally through the opening, a sleeve operatively connected with thenail, pressure applying means 'operatively connected with the sleeve andmovable lengthwise relative thereto, and means interposed between thepressure applying means and the pin, for applying pressure to the pin tomove the latter relative to the nail in engagement with the face of theopening, causing a bending of the pin into holding relation with thebone fracture.

4. An instrument for securing fragments of a bone fracture, comprising atubular nail, having an offset opening in a side thereof, with anangular face extending traversely of the axis of the nail, a pinslidably mounted and entirely contained within the nail, said pin havinga shank in position to engage said face and to be deflected laterallythrough the opening, a sleeve operatively connected with the nail,pressure applying means operatively connected with the sleeve andmovable lengthwise relative thereto, and means interposed between thepressure applying means and the pin, for applying pressure to the pin tomove the latter relative to the nail in engagement with the face of theopening, causing a bending of the pin into holding relation with thebone fracture, and means forming a connection between the pin and theinterposed means for causing an extraction of the pin from the bonefracture upon moving of the pressure applying means in the oppositedirection.

5. A fracture securing instrument for a nail having a pin therein,comprising a sleeve having a head on one end thereof, a bolt extendinglengthwise through the sleeve and head and having means for moving thebolt lengthwise relative thereto, and a rod at the inner end of the boltin position to engage the pin for applying inserting pressure to the pinupon lengthwise movement of the rod in one direction.

6. A fracture securing instrument for a nail having a pin therein,comprising a sleeve having a head on one end thereof, a pin guidedetachably connected with the opposite end of the sleeve, a boltextending lengthwise through the sleeve and having a threaded connectionwith the head,

.pin for applying inserting pressure to the pin to deflect the pin uponmovement of the bolt in one direction, and means forming a detachableconnection between said rod and the bolt.

8. An instrument for securing fragments of a bone fracture, comprising atubular nail, having an offset opening in a side thereof, with anangular face extending traversely of the axis of the nail, a pinslidably mounted in the nail and having a shank in position to engagesaid face and to be deflected laterally through the opening, a sleeve, abolt extending lengthwise of the sleeve and having threaded connectiontherewith, and

means providing a detachable connection between the bolt and the nail towithdraw the nail from the bone fracture upon moving of the bolt in anoutward direction.

9. A fracture nail comprising an elongated body having a head connectedtherewith by a neck of gradually increasing diameter outward from thebody and outwardly from the point of penetration for causing impactionon insertion of said nail, a pin slidably mounted in the body, means onthe body for deflecting the pin laterally of the body int secureengagement with the fracture, and said head being externallyscrewthreaded.

10. A fracture nail comprising an elongated body having a head connectedtherewith by a neck of gradually increasing diameter outward from thebody and outwardly from the point of penetration for causing impactionon insertion of said nail, a pin slidably mounted in the body, means fordeflecting the pin laterally of the body .into secure engagement withthe fracture, said head being externally screw-threaded, and a capscrew-threaded on said head in position to cause pressure on the outerportion of the fracture when secured on the head.

11. A hip fracture nail comprising a tubular .body having an elongatedshank adapted for insertion into bone structure, an elongatedcylindrical element slidably mounted in the shank, means in the shank inthe path of the cylindrical element for deflecting the end of thecylindrical element laterally of the axis of the shank into permanentsecuring engagement with the fracture bone structure at one side of saidshank, and said body having an enlarged externally screwthreaded portionadjacent one of its ends.

12. A .nail for securing together fragments of a bone fracture, saidnail comprising an elongated substantially cylindriral member having anenlarged proximal end and a pointed distal end, said member having anelongated cylindrical passageway formed therein and extending coaxiallywith respect to the longitudinal axis of said member from said proximalend to a point intermediate said proximal and distal ends, saidpassageway then continuing toward said distal end at an angle to saidaxis and opening in a side of said member adjacent said distal end, saidpassageway slidably receiving an elongated cylindrical element therein,and said en- 7 larged proximal end having interior and exterior threadsformed thereon for connection with means for inserting said nail and pininto said bone fragments and means for Withdrawing said nail and pinfrom said bone fragments.

13. A device of the type described comprising an elongated tubularsleeve, a cap threadedly mounted on one end of said sleeve, said caphaving a central threaded opening formed therein, an elongated boltthreadedly mounted in said opening and extending at one of its ends intosaid sleeve at one side of said opening at one side of said cap, saidbolt having its other end projecting beyond the other side of saidopening at the other side of said cap, a manually operated handle, meansdetachably securing said handle on said other end of said bolt, said oneend of said bolt having a recess formed therein coaxial with thelongitudinal axis of said bolt, a tubular guide member having one of itsends threadedly connected with said other end of said sleeve, said guidemember having its other end threaded for connection with one endof atubular fracture securing nail and having a passageway formed thereinopening in a side of said nail, an elongated anchor pin for said nailslidably mounted therein, and a rod slidably mounted within said guidemember, said rod being threaded at one of its ends for threadedconnection with one end of said pin, [the other end of said rod beingjournaled within said recess whereby said bolt may be rotated relativeto said rod.

14. A fracture securing instrument comprising an elongated tubularsleeve, a cap detachably mounted on one end of said sleeve, said caphaving a threaded central opening formed therein aligned with thelongitudinal axis of said sleeve, an elongated bolt threadedly mountedwithin said opening and having one end portion thereof on one side ofsaid cap disposed Within said sleeve, said bolt having its other endprojecting beyond the other side or said cap, manually operated handlemeans detachably connected to said other end of said bolt, a tubularguide member having one of its ends detachably secured to said other endof said sleeve, and slidably mounted within said guide member and.extending therethrough, said rod having one of its ends disposed withinsaid sleeve and. in abutting relationship with said one end of saidbolt, means on the other end of said guide member for detachableconnection with one end of a tubular fracture nail, and. means .on theother end of said rod for detachable connection with one end of a pinslidably mounted within said nail.

15. A device of the type described comprising ing a central openingformed therein and thread- 6 edly mounted on said one end of saidsleeve, an elongated bolt slidably mounted within: said opening andhaving one of its ends disposed within said sleeve at one side of saidcap and its other end projecting on the other side thereof, aninternally threaded recess formed in said one end of said bolt, atubular guide member externally threaded at one of its ends forconnection with the internally threaded other end of said sleeve, a rodslidably mounted in said guide member, one end of said rod beingexternally threaded for connection with said internally threaded recessformed in said one end of said bolt, said guide member having internalthreads formed on the other end thereof for threaded connection with oneend of a hollow tubular fracture securing nail, and said rod havingthreads formed on the other end thereof for connection with one end of apin slidably mounted within said nail, and means coacting with said capand other end of said bolt for withdrawing said pin from said nail.

16. An instrument for Withdrawing a fracture securing nail from fracturefragments comprising an elongated sleeve, a cap detachably secured toone end of said sleeve and having a central opening formed therein, anelongated exteriorly threaded bolt slidably mounted in said opening andhaving one end thereof disposed within said sleeve on one side of saidcap, said bolt having its other end projecting on the other side of saidcap, said one end of said bolt having an internally threaded recessformed therein, a coupling member slidably mounted within said sleeveand having opposed threaded ends, one end of said member being threadedinto said internally threaded recess formed in said one end of saidbolt, said other end of said member being adapted for connection withone end of said nail, and means coacting with said cap and said bolt forwithdrawing said nail from said fracture fragments.

ALFRED T. PURIFICATO.

REFERENCES CITED The following references are of record in the file ofthis patent:

V UNITED STATES PATENTS Number Name Date 324,768 Hunt Aug. 18, 18852,077,804 Morrison i Apr. 20, 1937 2,187,852 Friddle Jan. 23, 19402,222,517 Price Nov. 19, 1940 2,327,434 Johnston Aug. 24, 1943 2,396,276Lang Mar. 12, 1946 2,490,364 Livingston Dec. 6, 1949 OTHER REFERENCESIndustrial & Engineering Chemistry for November 1937, page 1316. (Copyin Scientific Library.)

Catalog of De Puy Mfg. Co. of Warsaw, Indiana. 1943, pp. 48-49. (Copy inDiv. 55.)

